Health Matters

I had not planned to write about Nigeria’s poor health status, clearly evident in my column this week. But last week there was a mild protest in Lagos by health care workers to call the nation’s attention to the deplorable state of health care delivery system in Nigeria and the appalling conditions of health care workers. Then there were one or two articles in the media warning about the deteriorating situation of health care in our country. Shortly after that I received an alarming tweet that Nigeria ranked 187 of 190 nations whose health status was surveyed in 2000 by the World Health Organization (WHO). I found this shocking and disturbing. I had no idea that health care in our country was that bad. Of the African countries on which the survey was carried out, only the Democratic Republic of the Congo (DRC) and the Central African Republic (CAR) ranked below Nigeria in terms of health care, with Myanmar bringing up the rear.

Even though I was fully aware of the appalling state of Nigeria’s health care delivery system and its deterioration in recent years, I still found the alarming report attributed to the WHO incredible. I decided I would google the WHO report myself. What I found out about the global health ranking of Nigeria was even more disturbing. The WHO report for 2014 showed that of the 200 countries surveyed, Nigeria ranked 197 in health care delivery. Again, only the DCR the CAR and Myanmar still ranked below Nigeria. All other African countries on which the WHO carried out a medical survey in 2014 ranked above Nigeria. Absolutely shocking.

Here are some of the randomly selected incredible WHO rankings for African states in health care: Morocco, the African leader (29), Senegal (59), Libya (87), Benin Republic (97), Burkina Faso (132), Ghana (135), Cote d’Ivoire (137), Burundi (143), Uganda (149), Zimbabwe (155), Cameroon (164), Rwanda (172), Chad (178), Somalia (179) and Ethiopia (180). All those countries, including war- torn Sudan (134) and Somalia (the failed state), ranked incredibly above our own country, Nigeria. How come Nigeria, an oil producing country, touted as the largest economy in Africa, ranked so low in WHO’s ranking of global health care? All our relatively poorer West African neighbours, including Chad, Niger, Togo, Burkina Faso, were ranked higher than Nigeria in health care delivery. So were Ghana and Cameroon. Further afield, Tanzania, Zimbabwe, Rwanda and Burundi, all vastly poorer than Nigeria, were reported as having better health care delivery systems than Nigeria. Now, Nigeria’s low ranking is not due solely to its large population. China, India and Brazil have large populations too, but rank far ahead of Nigeria. They spend a lot more on health care than Nigeria.

When I checked the WHO data for health care in Nigeria it was even more disturbing. In virtually all cases we were worse off than other African countries. From 85 in 2000, infant mortality has increased to 110 per 1000 live births in 2014, globally one of the worst. The rate of maternity deaths has also increased substantially. The WHO had recommended that all states should commit 15 per cent of their annual budgets to health care. Nigeria signed the protocol to this WHO recommendation, but it has always fallen way below it. In the last two or three decades Nigeria’s total annual expenditure on health care has averaged only 3.7 per cent instead of 15 per cent prescribed by the WHO. The average for Africa was given as 8 per cent, more than double that of Nigeria. In 2016, while Nigeria spent only US$40 million on its health care, Kenya, a much smaller and poorer country, spent over US$100 million on its health care. It was only in 1998/9 and 2002/3 that Nigeria spent 5 per cent of its budget on health care. These figures include expenditure on health care by the states. The WHO recommends the annual expenditure of US$3400 per head on health care. Nigeria’s average as at 2014 was only US$217. As the WHO report observed, “Nigeria lacks a serious approach to health care”. In fact, the situation is worse at the level of primary health care which, due to wilful neglect, has declined very rapidly over the years. When he was Minister of Health, the late Professor Olikoye Ransome Kuti tried very hard, and with some success, to reform and stabilise our primary health care system.

But the improvements he made in our primary health care have not been sustained largely due to our failure to increase public expenditure on health care. The WHO report also referred to poor training facilities for health care workers and lack of the necessary medical equipment in our hospitals, including the most advanced. We have over 50 university teaching hospitals, but they all lack the necessary medical equipment to function maximally. This situation applies to the private hospitals as well. Very often surgeries cannot be performed on patients because of the irregular and uncertain power supply, In both urban and rural areas of our country, access by the poor to health care is very poor. The limited private health care available mostly in the urban areas is very expensive. Children, women and the elderly are highly vulnerable to this appalling lack of an efficient and affordable health care delivery system. Where it exists at all, the facilities are very poor and inadequate. The national health insurance scheme is a total failure. It covers only a negligible few. To further complicate matters, drugs, most of which are imported, have become outrageously expensive, due to the exchange rate adjustment of the naira. Only the rich can afford them. The poor now resort increasingly to self medication, quacks, or dubious herbalists for their health care. It is estimated that there are 4,000 Nigerian trained doctors now living and working in the US and Britain. There could be another 1,000 of them working elsewhere. Most of them emigrated abroad because of poor pay and poor working conditions here at home. Our rich now routinely go abroad for medical treatment because they know what is available locally is wholly inadequate. And because they can afford private health care they care very little about the appalling state of public health care in our country. Right now, President Muhammadu Buhari is receiving medical attention abroad. President Yar’Adua died while receiving medical care in Saudi Arabia. This is a national shame and embarrassment.

Now, despite competing financial needs, I believe Nigeria can afford an efficient and respectable health care delivery system. What is lacking is the commitment of its leaders to this objective and the vast public corruption that diverts huge financial resources away from investment in human development. Cuba, under its late leader, Fidel Castro, showed, within a generation, what a committed leadership can do for health care, particularly at the primary level. Cuba, despite its financial constraints, has one of the most advanced health care delivery programmers in the world. It concentrates mainly on primary health care. The development of physical infrastructure (roads, electricity and public transportation) is important. But the development of social infrastructure (health and education) is even more important. Investing in the development of social infrastructure is even more profitable. It should be treated as a priority in public expenditure. It creates more jobs and has a more positive effect on the economy.

Health care matters. Health is wealth. A healthy nation is a prosperous nation. Its workers are more productive. Some of the social divisions and conflicts in our country are made worse by the existing poor health care. Though there can be no justification for it, the poor are tempted to take to crimes, such as kidnapping and armed robbery when they are unable to meet their health challenges and medical bills. A good and affordable public health system will reduce some of the violence in our country. Nigeria does not lack the financial resources to improve on its health care. In 1953, when Chief Obafemi Awolowo introduced his free health programme in the then Western Region, he committed 50 per cent of his government’s budget to health and education. That gave the Western Region a good start in health care, which it has maintained since. The region is far ahead of other regions of Nigeria in health care. We must find a way of getting our governments at all levels to commit themselves to meeting the WHO prescription of spending 15 per cent of our annual budgets on heath care. The National Assembly must take the bull by the horns. It should pass the necessary legislation that will compel the Federal Government to meet its financial obligations in that respect to a better health care delivery system. In addition the importation of vital drugs should be made easier and cheaper by lowering the tariff or duty on imported drugs.